NORCET 2 -2021 (Shift-2)
Medical & Surgical Nursing
Hard
A nurse is going to start the peritoneal dialysis. Which is a first priority action of the nurse? (NORCET 2023)
Appeared in: NORCET 2 -2021 (Shift-2)
Explanation
- Warming the dialysate solution to body temperature (37°C or 98.6°F) is a critical preparatory step before instillation.
- Using warm fluid prevents patient discomfort, abdominal cramping, and hypothermia.
- Warmth causes vasodilation of the peritoneal blood vessels, which increases the surface area for diffusion and enhances the clearance of metabolic wastes, making the treatment more effective.
Why Other Options Were Wrong
- Option A: Applying a Foley's catheter is an invasive procedure that increases the risk of urinary tract infections. It is not a routine first step.
- Option B: Assessing for a bruit (a whooshing sound) and a thrill (a palpable vibration) is the correct procedure for checking the patency of an arteriovenous (AV) fistula or graft.
- Option C: The standard patient position for the inflow phase of peritoneal dialysis is supine or semi-Fowler's to allow for even distribution of the dialysate.
Related Visual
- Visual 1: Diagram illustrating the process of peritoneal dialysis, showing the catheter, peritoneal cavity, and dialysate bag.
- Visual 2: Infographic comparing the key differences between Peritoneal Dialysis and Hemodialysis, highlighting access sites (PD catheter vs. AV fistula) and procedures.
Clinical Relevance
- Nursing practice connection: Safe nursing care depends on performing Priority nursing interventions for initiating peritoneal dialysis in the correct sequence, documenting the action clearly, and monitoring for the expected response.
- The highest priority in ongoing peritoneal dialysis care is maintaining strict aseptic technique to prevent peritonitis, a life-threatening complication.
- Nurses must educate patients on recognizing early signs of peritonitis, such as cloudy outflow, abdominal pain, and fever, and to report them immediately.
- What if? If the patient reports severe abdominal pain during inflow, the nurse's first action should be to slow the infusion rate and assess the patient. If pain persists, stop the exchange and notify the provider, as it could indicate a problem with the catheter or dialysate temperature.
How to Approach the Question
- First, identify the specific procedure mentioned in the question: 'peritoneal dialysis'.
- Read the lead-in carefully: 'first priority action'. This asks for the most important initial step among the choices.
- Evaluate each option in the context of peritoneal dialysis. Option B mentions 'bruit and thrill', which is a hallmark assessment for hemodialysis. This can be eliminated immediately.
- Consider the sequence of events. Emptying the bladder is necessary, but catheterization (Option A) is not the standard first-line method. Positioning (Option C) is important, but the position described is for drainage, not inflow.
- Analyze the remaining option. Warming the dialysate (Option D) is a fundamental preparatory step for patient safety (preventing pain and cramping) and treatment efficacy. This makes it the highest priority among the given actions.
Concept Tested & Keywords
- Concept Tested: Priority nursing interventions for initiating peritoneal dialysis.
- Stem keywords: peritoneal dialysis, start, first priority action
- Lead-in keywords: first priority
Question ID
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Practise the full NORCET 2 -2021 (Shift-2)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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